HEALTH PROTECTION AGENCY

MINISTRY OF HEALTH

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© All rights reserved. No parts of this publication may be altered. Short excerpts from the

publication may be used with proper reference acknowledgement to this document.

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Acknowledgment

Ministry of Health

Health Protection Agency

Indira Ghandi Memorial Hospital

ADK Hospital

Maldives Medical Association

Dhamanaveshi

Faculty of Health Sciences

Ministry of Fisheries and Agriculture

Society for Health Education

Maldives Food and Drug Authority

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Contents Acknowledgement…………………………………………………………….2

Glossary……………………………………………………………………….4

Forword………………………………………………………………………...6

Introduction…………………………………………………………………...7

Dietary guidelines for Maldivians……………………………………………. 9

Guideline 1: Eat a variety of food from the main five food groups….....10

Food guide……………………………………………….………….…11

Guideline 2: Include fruits and vegetables in your diet daily…………. 27

Guideline 3: Limit intake of saturated fat, avoid trans fat and use other fats and

oils in moderation……………………………………………………… 28

Guideline 4: Limit intake of sugar…………………………………….. 31

Guideline 5: Limit intake of salt………………………………………. 34

Guideline 6: Limit intake of junk food and ultra processed food…..…36

Guideline 7: Drink plenty of water and choose water over sugary drinks

……………………………………………………………………. 37

Guideline 8: Maintain a healthy weight………………………………. 38

Guideline 9: Be physically active most days of the week……………. 40

Guideline 10: Practice 5 keys to safer food…………………………… 42

Guideline 11:

For Infants, breastfeeding should be initiated within the first hour of life, and be

exclusively breastfed for six months, with timely introduction of nutritious,

adequate, safe and properly fed complementary foods while continuing

breastfeeding for up to two years of age or beyond…………………….46

Guideline 12: Follow healthy dietary practices during pregnancy and

lactation….……………………………………………………………..48

Guideline 13: Practice healthy eating and be physically active during

adolescence…………………………………………………….………51

Guideline 14: Pay attention to nutritional needs in elderly……………. 53

Annex 1: Dietary habits to prevent from lifestyle related diseases..…54

Annex 2: Reading food labels………………………………..………55

Annex 3: Healthy meal ideas…………………………………..…….56

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Glossary

Adolescent: A person aged 10 to 19 years inclusive.

Adult: A person 18 years and above.

Child: A child is a person 17 years or younger unless national law defines a

person to be an adult at an earlier age.

Complementary Feeding: The process starting when breast milk alone is no

longer sufficient to meet the nutritional requirements of infants, and therefore

other foods and liquids are needed, along with breast milk.

Early initiation of breastfeeding: Provision of mother’s breast milk to

infants within one hour of birth.

Elderly: A person aged 65 years and above.

Exclusive breastfeeding: Infant receives no other food or drink, not even water,

except breast milk (including milk expressed or from a wet nurse) for 6 months

of life, but allows the infant to receive ORS, vitamins, minerals and medicines.

Fad diet: Any diet that promises fast weight loss without a scientific basis.

These diets often eliminate entire food groups and as a result do not provide a

wide range of important nutrients.

Fruit juice: Must contain 100% fresh fruit, these are pure products with no

preservatives or sweeteners and no artificial colours, and may or may not

contain pulp of the fruit itself.

Infant: A child younger than one year of age.

Junk food: Foods that are highly processed or ready-prepared that has little or

no nutritional value and are usually high in calories.

Obesity: Having excess body fat.

Overweight: Having excess body weight for a particular height from fat,

muscle, bone, water or a combination of these factors.

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Overweight and obesity: The result of “caloric imbalance” too few calories

expended for the amount of calories consumed and are affected by various

genetic, behavioral and environmental factors.

Processed foods: Foods that have been treated to change their physical,

chemical, microbial, or sensory properties.

Ultra processed food: Industrial formulations which, besides salt, sugar, oils

and fats, include substances not used in culinary preparations, in particular

additives used to imitate sensorial qualities of minimally processed foods and

their culinary preparations.

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Introduction The goal of this dietary guideline is to help improve the nutritional status of the

Maldivian population and to help prevent diet related chronic diseases, also

known as non-communicable diseases (NCDs).

Diet plays a vital role in the health of an individual. A diet that it deficient,

in excess or with imbalance of nutrients, lead to malnutrition. Likewise, a diet

that provides adequate energy and nutrients helps in preventing life style

related diseases and help to maintain a healthy weight. Hence healthy

eating plays an integral role in obtaining optimal health and wellbeing.

Lifestyles of Maldivians are changing from traditional, home cooked diets and

an active lifestyle to a more sedentary one with intake of dietary energy from

a more ultra processed food based, energy dense diet with increased use of

saturated fats and simple sugars, including consumption of sugar sweetened

beverages. Although most of the islands are small, more people are relying on

motor bikes or other motored vehicles rather than choosing to walk or bicycle.

The negative effects of these changes are already being observed with the

increase in obesity and NCDs such as heart disease, stroke, cancer, diabetes

and high blood pressure. According to Maldives Demographic Health Survey

2009, 46% of Maldivian women are overweight or obese.1 NCDs account for

up to 81% of all deaths and is considered as the main cause of morbidity and

mortality in the country.2 Obesity among children is also an emerging trend in

Maldives. Health screening conducted for grade 1 students in 2015 showed

that 22% of children are overweight and obese.3

NCDs are preventable by modifying behavior through healthy lifestyle,

particularly avoiding tobacco use and exposure to second-hand tobacco

smoke, physical activity and healthy diets, and through early detection and

treatment of the intermediate risk factors: high blood pressure, obesity,

high blood sugar and elevated blood cholesterol. This food based dietary

guideline will help as a guide to modify the eating behavior and physical

activity, thereby helping to reduce the risk of NCD prevalence among

Maldivian population.

According to Food and Agriculture Organization, Food based dietary

guidelines are short, science-based, positive messages on healthy eating and

lifestyles intended to prevent malnutrition and to keep the population well-

nourished and healthy. The guidelines simplify the nutrition

recommendation so that that the public can easily understand, and focus on

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foods that should be commonly consumed, portion sizes, and eating

behaviors. These guidelines can be used as a nutrition education and behavior

change tool by health providers, teachers, journalists, and others working

directly with the public.4

The Food Based Dietary Guideline for Maldives is intended for the healthy

population (i.e. not having a specific illness that requires particular dietary

adjustments). Guideline includes some key messages specific for infants and

young children, adolescents, for pregnant and breastfeeding women and also

for elderly. Number of servings recommended in this guideline are for

moderately active adults; small children and older people need smaller

servings, while hard working men, adolescents, and pregnant and breast

feeding women may need more servings or may need to eat more often. Those

requiring special diet need to contact a Dietitian or other health professional

for further advice.

1Maldives health profile 2016. Ministry of Health

2WHO Global health Observatory. Noncommunicable diseases - country profile - Maldives: http://www.who.int/nmh/countries/mdv_en.pdf?ua=1 3Report of School Health Survey Grade 1, Ministry of Education 4http://www.fao.org/nutrition/nutrition-education/food-dietary-guidelines/en/

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1. Eat a variety of food from the main five food groups.

2. Include fruits and vegetables in your diet daily.

3. Limit intake of saturated fat, avoid trans fat and use other fats and oils in

moderation.

4. Limit intake of sugar.

5. Limit intake of salt.

6. Limit intake of junk food and ultra processed food.

7. Drink plenty of water and choose water over sugary drinks.

8. Maintain a healthy weight.

9. Be physically active most days of the week.

10. Practice 5 keys to safer food.

11. For Infants, breastfeeding should be initiated within the first hour of life,

and be exclusively breastfed for six months, with timely introduction of

nutritious, adequate, safe and properly fed complementary foods while

continuing breastfeeding for up to two years of age or beyond.

12. Follow healthy dietary practices during pregnancy and lactation.

13. Practice healthy eating and be physically active during adolescence.

14. Pay attention to nutritional needs in elderly.

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No single food can provide all the nutrients in the proper amount that our body

requires. A diet consisting of foods from different food groups provides all the

required nutrients in proper amounts. Foods high in fat and sugar provide energy

but tend to be low in nutrients. Moderation is the key and contributes to dietary

adequacy and balance.

A balanced diet helps to ensure that body receives all the essential nutrients, fibre

and energy in quantity enough to maintain optimal health.

Hence, we need to eat a variety of food from all the 5 food groups. The following

food groups are divided based on their function and the benefits they provide.

Cereals and starchy vegetables

Fruits

Vegetables

Fish, poultry, egg, meat, legumes and seeds

Milk and dairy products

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The ‘food guide’ is a pictorial guide intended to help Maldivian adults choose a

variety of nutritious foods over a period of time. The food guide displays food on a

plate, proportions that should be eaten daily. It does not provide quantities. For

specific recommendation for each food group, please refer to the guideline.

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The main component of this food group is carbohydrates. Carbohydrates provide energy

for our daily activities. Main cereals and starchy vegetables in our diet include; rice,

potato, yam, sweet potato, breadfruit, and products of wheat flour -mainly roshi, pasta,

bread, rusk [faaroshi] and cracker biscuits.

The amount of food you should consume from this food group depends on how

physically active you are. If you are an inactive person and consume too much food from

this food group, you are likely to gain weight. However, if you do a lot of exercise

regularly, you can consume servings recommended at the higher end.

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Health Benefits

Whole grain cereals such as atta flour, brown rice, bimbi and oats are rich in many

nutrients, including B vitamins, minerals and fibre. Whole grain cereals help to

maintain your blood sugar at a constant level and also helps to keep your bowel

regular and healthy. Eating whole grains regularly can help lower the risk of

diabetes, heart disease and certain types of cancer.

Always choose minimally processed grains such as brown rice, oats and products

made from unrefined grains, because it is higher in fibre and more rich in vitamins

and minerals. Polished and processed cereals such as white flour is very low in

fibre and other nutrients.

Whole grain products such as oats, atta roshi, bimbi and red rice will keep your

hunger away for a longer period than foods made from refined grains such as

polished rice/ roshi made from white flour. Eating whole grain regularly will help

to maintain a healthy weight.

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When preparing rice, roshi or pasta, limit fats such as cooking oil and

coconut products.

It is common practice for some Maldivians to eat cream crackers for main

meals or with evening tea. Cream crackers are high in salt and fat, it is not

considered as a healthy meal option. However, you can enjoy 2-3 crackers as

snacks occasionally.

Healthy snack options include; cut fruits and vegetables, unsalted nuts,

roasted unsalted sanaamugu and low fat unsweetened yoghurt.

Some whole grain cereals such as red rice and brown rice might take longer

to cook. Soak rice in water for about 30 minutes before cooking. This will

minimize the cooking time.

If you do not like the taste of atta roshi or find it too expensive to eat daily,

try mixing atta flour with normal white flour. Mixing white flour with ground

oats or other whole grains is also a healthier option. This will add more

nutrients and fibre, while having little impact on the taste.

Boiled plantain, breadfruit, yam, sweet potato and other starchy vegetables,

are better eaten as a main, rather than having it as a side dish. If you have

these with rice or roshi, it will add more servings from cereal group to the

meal.

If you consume bread, choose whole grain breads instead of white bread. Be

aware that not all brown breads are made from whole grain, some brown

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bread is normal white bread with food colourings such as caramel or brown

colour added to it. Hence it is important to read the ingredient list before

buying.

Just because a biscuit or cookie claims that it is high in oats or wholegrain it

might not necessarily be healthy. It could have a high amount of sugar and

fat added to it. Always read the nutrient content label and ingredient list on

the package.

Limit intake of faraata, huniroshi, frozen readymade roshi, farata, naan

because they have a high fat content.

Avoid deep frying potato, bread fruit and yam.

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Health Benefits

Including fruit as part of your regular diet is associated with reduced risk of heart

disease, stroke, obesity and weight gain, and some types of cancers.

Fruits are high in fibre, regular consumption of high fibre

food may reduce the risk of obesity, type 2 diabetes and

also, help to keep your bowels regular.

Fruits are a rich source of several vitamins and minerals

that are needed for the body. Fruit is high in vitamin C

and folate. Vitamin C is vital for growth and repair of

tissues, assist heal cuts and wounds, and helps to keep teeth and gums healthy.

Folate helps the body to form red blood cells and reduces the risk of neural tube

defects. Most fruits are high in potassium. Diets rich in potassium may lower blood

pressure, and help to decrease bone loss.

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It is good to limit the intake of fruit juice and always advisable to eat whole

fruit, because it contains the fibre that help you feel full. Fruit juices, although

containing most of the micronutrients of the whole fruit, would have most of

the fibre removed and some people tend to add sugar to it, and are therefore

high in free sugar and calories. Not more than half a cup (125 ml) of 100%

fruit juice should count for the daily 2 to 3 servings of fruits.

If you are eating dried fruits such as raisins, dates or prunes, do it in

moderation and choose dried fruit without added sugar. Dried fruits can be

sprinkled on fruit salads, vegetable salads or cereals. Dried fruits have a high

amount of sugar.

Canned or frozen fruits can also be used if fresh fruits are not available. Try

to look for fruits canned or packed in natural juice and only use the fruit. The

‘syrup’ in cans are high in sugar, and is best not used.

Try to consume different varieties of fruits as you can afford because

different fruits are rich in different nutrients.

Cut fruits are easy and healthy snacks and can be easily packed and taken to

work or given as snacks for school interval. Some whole fruits like apples,

banana, water apple or stone apple are ready to eat, immediately after

washing well or simple peeling, and are very handy as ‘on-the-go’ foods.

If you would like a healthy and easy dessert, make a fruit salad.

Locally grown fruits are as nutritious as imported ones. Try to include locally

grown and easily available fruits in your diet, as they can be much fresher

than imported ones.

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Some locally grown fruits include: Banana, Mango, Guava, Pomegranate,

Papaya, Watermelon, Passionfruit, Stone apple (Kunnaaru), Water apple

(Jamburoalu), {Jambu}, {Dhambu}, {Moonima}, Noni fruit (Ahivah),

Mangrove apple (Kulhavah), Sea almond fruit (Dhonmadhu), Jeymu,

Custard apple (Atha),{Dhaagandukekuri},

{Muraaki},{Kalhuhuthumeyvaa}, {Sabudheli}

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Health Benefits

Including vegetables as part of your regular diet is associated with reduced risk of heart

disease, stroke, obesity and weight gain, and some types of cancers.

Vegetables are high in fibre, regular consumption of high fibre food may reduce the risk

of obesity, and type 2 diabetes. Regular consumption of vegetables also help to keep your

bowels regular. Consuming vegetables with each meal will help you feel full and replace

high calorie food.

Vegetables are important sources of many nutrients, including

potassium, dietary fibre, folate, vitamin A, and vitamin C. Diets rich

in potassium may help to maintain healthy blood pressure. Vitamin

A keeps eyes and skin healthy and helps to protect against infection.

Starchy vegetables like potato, sweet potato and yam are categorized under cereals food

group because they provide similar nutrients and are predominantly high in carbohydrates.

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Try to include as many varieties and different colours of vegetables.

If you are using canned vegetables, drain the liquid and rinse well with water.

This will help to reduce the salt content.

To retain the nutrients, steam instead of boiling and do not overcook.

Try to include locally available green leaves daily. Some commonly

available greens in Maldives include; Kankun, Moringa leaves{ Muranga},

{Kulhafilafayy}, {Dhiguthiyarafayy}, {Massaagufayy}, {Copee fayy},

spinach (boaveli), lettuce.

Raw vegetables such as carrots and tomatoes can be used as a snack.

Avoid deep frying vegetables and green leaves (eg: Thelulifayy). Try grilling

instead (eg: butternut pumpkin, eggplant).

Even if you are eating rice and garudhiya,

make it a habit to eat vegetables (eg:

cucumber, green leaves)

Try home gardening if you have space at

home and enjoy home grown fresh products.

Many vegetables and leaves are quite easy

to grow and save on expenses too.

Plan meals ahead so that you can avoid

buying in excess that could spoil.

Try vegetables you don’t usually cook at home. This helps to increase variety

in your diet.

Try to eat most of the vegetables with skins and seeds, as these are often rich

in nutrients.

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Health Benefits

The main component of this food group is protein. Protein is required for growth

and repair of cells such as in your muscles and skin. Protein is also required to

make enzymes and hormones in our body.

Eating a variety of foods from this food group provides protein, iron, zinc and other

minerals and vitamins, especially B vitamins. Animal based food are the main

source of vitamin B 12.

Locally available fish is a good and safe source of protein. Oily fish such as tuna

is a good source of omega- 3 fatty acids which is good for our heart health. Eating

fish regularly could reduce the risk of dementia in elderly, heart disease and stroke.

Fish liver is a good source of vitamin A. However, do not eat it in excess during

pregnancy, especially during first trimester.

Fish liver is also a rich in vitamin D. Vitamin D is important to keep your bones

healthy.

Lean red meat such as mutton and beef are good sources of iron. Regular intake of

large quantity of red meat is not recommended because it could increase the risk

of certain types of cancers.

Chicken and egg are good sources of protein and other nutrients. Eating one whole

egg per day does not have an effect of blood cholesterol for healthy individuals.

Nuts, seed and legumes are rich in protein, iron, zinc, fibre and many other

nutrients. Fibre helps to regulate blood sugar level, helps to lower blood cholesterol

and helps to lower the risk of heart disease.

Processed meat such as sausages and luncheon meat are very high in saturated fat

and salt and are not part of this food group. It should be avoided as far as possible.

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Removing the skin from chicken before cooking reduces the fat content.

Chicken breast contain less fat compared to chicken thigh or chicken wings.

If you are eating red meat, remove all the visible fat.

Rinse canned beans/ chickpeas before eating, to reduce the salt content.

Dhaal curry (Muguriha) if cooked with less coconut milk is a nutritious

food for the whole family.

When consuming legumes, include food high in vitamin C such as green

leaves and lime to enhance the iron absorption. Having tea with meals

reduces iron absorption from food. Wait for 30 minutes after meals if you

want to drink tea.

Avoid deep frying fish, meat or chicken.

Roast, bake or grill instead.

Do not throw away the seeds in

pumpkin, roast and have it as a snack.

They are very nutritious and may help to

lower blood cholesterol.

If you are having nuts and seeds, go for

unsalted ones and eat in moderation.

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Health Benefits

Low fat milk and dairy products are best for everyone except young children.

Milk, yoghurt and cheese are rich in protein and calcium and other minerals and

may protect against high blood pressure and contribute to stronger bones and

teeth.

Butter, cream, ice cream, flavoured sweetened milk, condensed

milk and flavoured sweetened yogurt, loaded with sugar do not

provide these health benefits.

Babies under 12 months of age should not be given cow’s milk.

Children under 2 years of age should not be given low fat milk

or other low fat dairy products. Milk fat is an important source of energy, certain

vitamins and important types of fat for this age group.

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Avoid condensed milk and creamers, these are high in sugar.

Limit intake of processed cheese. It is high in salt and fat.

Some people cannot tolerate milk, (a condition called ‘lactose intolerance’)

because they do not have the enzymes to digest lactose, the sugar in milk.

Those who cannot tolerate milk can try lactose free milk or soy milk.

Try plain yoghurt with cut fresh fruits as a healthy snack option.

When you prepare milk from milk powder, avoid adding sugar and other

malt drinks. Most malt drink products also contain large amount of added

sugar. Common malt preparations available in the market currently include

Milo, Ovaltine and Bournvita.

When buying yoghurt, make sure that you are really buying yoghurt and

not a dairy dessert loaded with sugar

and fat. Yoghurt will have bacterial

culture added to it. Always check the

label and make sure that it has the

word “yoghurt” written on it. Real

yogurt will also have a very short

shelf life before expiry. There are

many products that resemble yoghurt

available in the market but most are

just dairy desserts which are very

high in fat and sugar content.

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It is important to consume a variety of fruits and vegetables to provide the

nutrients our body require. Diet high in fruits and vegetables have been

shown to reduce the risk of chronic diseases such as cancer and heart

disease. Fruits and vegetables are high in

antioxidants which could help prevent

cancer and heart disease. It is also thought

that antioxidants and other protective

constituents from fruits and vegetables

need to be consumed regularly from early

life, to be effective. Locally available fruits

and vegetables are also good sources of

antioxidants. Evidence suggest that

antioxidant supplements do not work as

well as the naturally occurring antioxidants

in fruits and vegetables. Fruits and vegetables are not only high in

antioxidants, but they also provide other nutrients, such as folate,

magnesium, potassium and dietary fiber, vitamins A, C, and K. They are

also low in saturated fat and calories.

Select seasonally and locally available fruits and vegetables such as water

melon and mango.

If you want to get the full benefit from fruits and vegetables, avoid deep

frying, adding sugary syrups, sauces and too much of high fat salad

dressings, when fruits and vegetables are prepared and consumed.

Select a wide variety of fruits and

vegetables.

Always choose whole fruits instead of

opting for pulp free fruit juices. Whole

fruits contain fibre that will help you

keep fuller for longer and could reduce

the risk of many chronic illnesses.

Canned and frozen fruits and vegetables can be used if fresh products are

not available.

Whenever possible, use the entire fruit or vegetable, peel and membrane

should be consumed to increase fiber intake.

Scrubbing visible dirt particles and thorough washing of fruits and

vegetables with water is effective in reducing many pesticide residues.

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Our body needs fat from the diet to provide energy and to support cell

growth. Fat also protects the organs and helps to keep the body warm. Fat

helps to absorb some nutrient such as vitamin A, D, E and K and helps to

produce some hormones too.

There are different types of dietary fats

and consumption of these have

different impacts on our health. There

are 4 main types of fat in the food we

eat;

o Saturated fat

o Trans fat

o Monounsaturated fat

o Polyunsaturated fat

Saturated fat is found mostly in animal sources such as fatty beef/ mutton,

chicken with skin, butter, cream, cheese and full cream milk. Saturated fat

is also found in plant sources such as coconut and palm oil. Many baked

goods such as biscuits, cakes, pastries and deep fried food such as short

eats(hedhika) contains high level of saturated fat.

We use coconut and coconut milk in our daily cooking. Make it a habit to

minimize the amount you use in cooking. Instead of using thick coconut

milk, we can use a small quantity of coconut and use thin coconut milk for

cooking. If you are preparing mas’huni, use less coconut and add more

vegetables such as {copee fayy}, eggplant, pumpkin,drumstick,snake

gourd or cabbage.

Eating too much saturated fats increases blood cholesterol level (in

particular LDL, commonly known as bad cholesterol), thereby increasing

the risk of heart disease and stroke.

The main food source for trans fat in processed food is industrially

produced “partially hydrogenated oil”. Make it a habit to look for it from

the ingredient list on food packages. Some oils and margarine available in

our market contains partially hydrogenated oil. Cholesterol is not found in

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food products made from plants hence none of the vegetable oils will

contain cholesterol. The label might say that the product is “cholesterol

free” however if the product is high in saturated fat/ trans fat, consumption

of that product could cause the blood cholesterol to increase. Some

restaurants and fast food outlets use trans fat to deep fry the food

repeatedly; this further creates more harmful toxins.

Trans fats can be found in deep fried food such as donuts and baked food

such as certain cakes, biscuits, cracker and some margarines and spreads.

It is becoming common

practice to consume frozen

faratas/roshi, nuggets,

wafers and packaged cakes

most of these products also

contain high amount of trans

fat.

Trans fat increases the risk

of heart disease by

increasing the bad

cholesterol (LDL) and

reducing the good

cholesterol (HDL) in our

blood. Avoid trans fat

consumption as much as

possible.

It has not been determined whether the small amount of trans fat that is

found naturally in dairy products cause increase in blood cholesterol as the

trans fat in industrially manufactured products.

Replace saturated fats and trans fats with healthier fats such as

monounsaturated fat and polyunsaturated fat. This will help lower your risk

of heart disease.

Foods high in monounsaturated fat includes: sunflower oil, olive oil,

avocado, peanuts, cashew nuts, almonds, canola oil and sesame oil.

Food sources of polyunsaturated fats include; fish, walnut, pine nuts,

soybean, sunflower, safflower, and canola oil.

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All 4 types of fats provide the same amount of calories. Consuming high

level of calories regardless of the source can cause weight gain. Hence, we

have to use fats in moderation.

It has become increasingly common practice to use oil for deep frying

purposes too. Deep frying is not recommended even with monounsaturated

fats and polyunsaturated fats (eg: olive oil).

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Consuming too much sugar and too

many foods and drinks high in sugar

can lead to weight gain, which in turn

increases the risk of heart disease, type

2 diabetes, stroke and some cancers. It

is also linked to tooth decay in both

children and adults. We need to limit

the intake of sugar sweetened

beverages such as soft drinks, fruit

drinks, 3 in 1 coffee and cereal packets,

flavored milk and the sugar added to

hot beverages such as tea and coffee.

Reducing the intake of free sugars to less than 25 grams or 6 teaspoons per

day (5% of total energy intake) would provide additional health benefits.

“Free sugars” include monosaccharides (glucose or fructose) and

disaccharides (sugar or sucrose, malt or maltose) added to foods and

beverages by the manufacturer, cook or consumer, and sugars naturally

present in honey, syrups, fruit juices and fruit juice concentrates. However,

milk sugars are not free sugars and therefore are not counted as part of the

5 or 10 %.

WHO recommendations5

WHO recommends a reduced intake of free sugars throughout the life

course

In both adults and children, WHO recommends reducing the intake

of free sugars to less than 10% of total energy intake.

WHO suggests a further reduction of the intake of free sugars to below

5% of total energy intake.

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Sugar can also be listed as: sugar, sucrose, glucose, fructose, high fructose

corn syrup or malt in packaged food. Always remember to check the

ingredient list. They are listed in order of what ingredient is highest in

weight to lowest in weight.

Added sugars can increase the calorie content of our diet and reduce the

consumption of important nutrients when we eat these foods in place of

foods from the five food groups.

Have desserts such as custard, pudding, bondibayy

(saagu/handoo/bambukeyo) and kandhi only on special occasions.

By gradually cutting down the sugar we add to our food and beverages, we

can train our taste buds to depend less on sweetness to enjoy the taste of

food.

Some Maldivians have the misconception that honey, brown sugar and

even palm sugar syrup (dhiyaahakuru) as low calorie substitutes for sugar.

But this is not the case. These are all free sugars that have the same negative

impact on our body as sugar.

Even if a packaged juice says “no added sugar”, it does not mean that it

doesn’t contain sugar, it simply means that no sugar is added during

production, however it will still have fruit sugar minus the fibre.

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Be careful of the hidden sugar in sauces, salad dressings and some dried

fruits.

Many Maldivians are used to eating aracenut products such as killi, which

is also loaded with sugar. Remember that even this will add empty calories

to your diet and is bad for your oral health.

Keep cakes and biscuits only for special occasions.

5Guideline: Sugar intake for Adults and children (2015): WHO

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Salt is an acquired taste. Almost all natural food items contain some amount of

salt that is adequate for functions of the body. Added salt is not required.

However, because of the traditional practices we add salt to food and as a result

many people are used to foods that are high in salt. High consumption of salt over

time can increase risk of high blood pressure. High blood pressure and its

complications lead to heart disease and stroke. A diet low in salt and high in

potassium lowers blood pressure. Reduction of salt intake to less than 5 grams per

day for adults, helps to reduce blood pressure and risk of heart disease, stroke and

heart attack.

The recommendations apply to everyone except for individuals with

illnesses or taking drug therapy that may lead to low sodium level in the

blood or those who require a supervised diet. For this recommendation,

“adults” refer to individuals ≥16years of age and “children” refers to

individuals 2–15 years of age.

Eating too much salt can raise blood pressure at any age.

You need to be aware of the hidden salt in processed food. Breads, biscuits,

sauces, processed meat such as sausages/ luncheon meat, instant noodles,

instant soups, cheese, breakfast cereals are all high salt products. Locally

made products such as rihaakuru, kulhi kaajaa and hedhika are high in salt

too.

WHO recommendation6

o WHO recommends a reduction in sodium intake to reduce blood

pressure and risk of cardiovascular disease, stroke and coronary heart

disease in adults. WHO recommends a reduction to < 2g of sodium

(5g/day salt) in adults.

o WHO recommends a reduction of sodium intake to control blood

pressure in children. The recommended maximum level of intake of

2g/day sodium in adults should be downwards based on the energy

requirement of children relative to those of adults.

35 | P a g e

Stock cubes, MSG (Monosodium glutamate or Ajinamoto), sauces such as:

soy sauce, oyster sauce, tomato sauce are all high in salt and if used in

cooking, should be used only occasionally.

Choose foods that are naturally low in salt such as fruits, vegetables, nuts,

seeds and meat, fish, and poultry. Add minimum salt when cooking.

Instead of relying on salt, add more flavour to your food my adding, lime,

herbs such as coriander leaves, lemon grass, curry leaves, rampe leaf,

garlic, ginger, vinegar and spices. You can also marinate fish and meat prior

to cooking to add more flavour.

If you start to decrease your salt intake gradually, your taste buds will adjust

to it. Once you are adjusted to eating low salt food, you will not prefer to

have salty food again. Try to train your taste buds for reduced salt food.

It has become common practice to give highly processed snack packets

such as cheese balls and chips to children. Most of these snacks are very

high in saturated fat and salt. Avoid giving these to children. If you can

train children to have low salt food, when they will grow up, they are more

likely to enjoy food with less salt.

Some Maldivians have a misconception that cream crackers are a healthy

option. Most crackers are very high in saturated fats and salt. Do not replace

healthy meals with cream crackers.

While eating out at a restaurant, you can request to add less salt to food.

6 Guideline: Sodium intake for adults and children (2012): WHO

36 | P a g e

Consumption of processed and ultra processed food is becoming

increasingly common in Maldivian diet. Commonly consumed processed

food includes; instant noodles, processed meat such as luncheon meat and

sausages, different types of fruit drinks, energy drinks, fizzy drinks and

flavoured sweetened milk, different types of biscuits, cakes and wafers.

Traditional homemade roshi is slowly getting replaced with store bought

frozen roti/ farata and naan.

Canned beans and canned

fish, although are processed

food, it can be considered as

healthy options.

Processed foods and junk

food are usually high in

refined sugar, salt, saturated

and trans fats associated with

obesity and diet related

chronic diseases.

Highly processed food and

junk foods are usually very high in saturated fat, salt and sugar, all of which

should be limited in our diet. Mostly, these foods provide only high

amounts of energy and little or no micronutrients, as they contain less fruits

and vegetables.

Limit consumption of fast food and processed food and try to cook healthy

and eat homemade food most days.

Fast food outlets are becoming increasingly common and unknowingly

people are choosing convenience over health. More and more fast food

outlets offering different range of fast foods such as burger, pizza and

submarine are being opened and promoted throughout the country. It is

important to choose healthy food even when eating out.

37 | P a g e

Water is involved in many functions of the body hence is essential for life. We

get water from food and drinks, however most water comes from the fluids we

drink. Adults under normal circumstances need 1.5 to 2 litres of fluid per day.

Always choose water as your preferred drink rather than juices, fizzy drinks or

other sugary drinks. Your water requirement will depend on your diet, climate

and your level of physical activity. Increase your water intake in hot weather and

when you are more physically active.

It has become common practice for some Maldivians to have fruit drinks such as

fruit cordials or powdered fruit drinks with meals. Most of these are high in

artificial flavours, colours and are very high in sugar. These will give you only

empty calories without nutrients and increases your risk of excessive weight gain

and tooth decay. Always choose water as a drink with meals.

Do not drink other fluids as an alternative to water.

Tea and coffee, although provide water, are not suitable for young children and

large quantities can have unwanted stimulant effects in some people.

Some people drink juice with meal because they don’t like the taste of water. If

you are one of them, try adding lime and mint leaves to enhance the taste of water.

This will help you save money and reduce calorie intake.

Elderly should drink water regularly even when not thirsty because they are more

prone to dehydration.

Our body could dehydrate without

enough water, which can be life

threatening. Drink water regularly, not

only when thirsty.

We often learn to ignore thirst due to

our busy lives. Learn to identify your

thirst and hunger, which is your body’s

need for water and food respectively.

If the water supply at home is rain

water, ensure that harvested rain water

is safe and clean.

38 | P a g e

Maintaining a healthy weight reduces your risk of type 2 diabetes, heart disease, high

blood pressure, certain types of cancers, problems of knee joint, respiratory conditions

such as sleep apnea, infertility and other reproductive disorders among many other

health problems. Focus should be on healthy eating and physical activity that can be

sustained over time, as it is a more effective way to lose weight than random efforts to

lose weight quickly over a short period. Your focus should not be only on losing weight.

Being obsessed about weight could lead to eating disorders. Being under weight is not

healthy either. It could

cause low immunity and

sometimes even

conditions such as

osteoporosis.

Body Mass Index (BMI)

is a measure of weight

relative to height. It can be

used to identify whether

you are at a healthy weight

range. It can be used for

adult, however should not

be used for children,

adolescents and it is not applicable for people with lots of muscle such as body builders

and for pregnant women.

BMI= Body weight (kg)/Height2 (m2)

BMI Weight Status

< 18.5 Underweight

18.5-24.9 Normal

≥25 Overweight

≥30 Obese

Waist circumference can also be used to assess health risk. Abdominal obesity is

strongly linked to heart disease. Abdominal obesity is defined as waist circumference ≥

90cm for South Asian men and ≥ 80cm for South Asian women.7 Waist circumference

responds to exercise and healthy diet more quickly than body weight, and can show you

whether you are going in the right direction even before you see a change in body

weight.

39 | P a g e

Eat healthy food regularly. Try to minimize high fat and high sugar food consumption.

Your diet should not be mainly based on junk food and processed food. Try to do regular

exercise.

Sugar sweetened beverages

such as carbonated drinks and

energy drinks should be

avoided.

If you are trying to lose

weight, choose reduced fat

dairy options such as low fat

milk and low fat yoghurt.

Avoid over the counter weight

loss pills and buying “slimming” pills and “fat burning” supplement over the internet

that promises weight loss. These supplement and pills could have detrimental effects on

your body.

Avoid diets that ask you to give up foods from main food groups and extremely low

calorie diets that claim rapid weight loss in short duration. It could cause harm to your

body and you are unlikely to maintain the weight, furthermore it could cause more

weight gain later on.

It is very important to watch your portion sizes. Do not eat large portion sizes. It is very

important to eat slowly and enjoy your

food. Plan your meals ahead and avoid

food shopping when you are hungry. Plan

quick and easy to cook meals on busy days.

When eating out, if the portion sizes are

large, share with a friend.

Maintain healthy eating even during

Ramazan and while fasting on other

months. Avoid consumption of oily deep

fried food and high sugar juices daily.

Follow the physical activity guide. Regular

physical activity will help you to maintain

weight. Spend less time sitting down. Sedentary lifestyle increases the risk of weight

gain and weight related health issues. If you want to gain weight, you need to increase

your intake from cereals, good fats and proteins. Eating food with more saturated fat,

trans fat and sugar could put you at risk of chronic diseases.

7 The IDF consensus worldwide definition of the metabolic syndrome retrieved from http://www.idf.org/webdata/docs/MetSyndrome_FINAL.pdf

40 | P a g e

Physical activity benefits all ages. Physical activity has been shown to reduce the

risk of numerous chronic conditions, including heart diseases, stroke, high blood

pressure, breast cancer, colon cancer, Type 2 diabetes and osteoporosis. It also

helps to relieve stress and, can help to regulate blood sugar and increase HDL

“good” cholesterol levels, and help maintain a healthy weight.

Physical activity also produces ‘feel good’ chemicals called endorphins, which

make you feel very happy, stimulated and satisfied after the activity. Regular

physical activity also improves your physique and strength and makes you fit and

less prone to illness.

Examples of moderate activity: brisk walking, gentle swimming.

Examples of vigorous activity: jogging, aerobics, sports such as football and

netball.

There are simple changes you can make in your daily routine that could help

you from to be more physically active. Avoid taking car or motorbike when

you go to nearby shops. Choose walking as your preferred mode of

WHO recommendations 8

1. Adults aged 18–64 should do at least 150 minutes of moderate-intensity

aerobic physical activity throughout the week or do at least 75 minutes

of vigorous-intensity aerobic physical activity throughout the week or

an equivalent combination of moderate- and vigorous-intensity activity.

2. Aerobic activity should be performed in bouts of at least 10 minutes

duration.

3. For additional health benefits, adults should increase their moderate-

intensity aerobic physical activity to 300 minutes per week, or engage in

150 minutes of vigorous-intensity aerobic physical activity per week, or

an equivalent combination of moderate- and vigorous-intensity activity.

4. Muscle-strengthening activities should be done involving major muscle

groups on 2 or more days a week.

41 | P a g e

transportation. Instead of taking the elevator, make it a habit to take the stairs.

Reduce your screen time. Do not spend too much time sitting at the computer;

take a break to do stretching.

Use physically active games as a fun way to enjoy with your family and

friends. Go swimming or play a sport as regular (e.g. weekly) family outings.

Remember that every step you take count towards your fitness and health.

8 Global recommendations on physical activity for health (2010): WHO

42 | P a g e

Occurrence of food borne diseases can be minimized and prevented by practicing

personal hygiene and proper food handling practices. The following are the 5 keys

to safer food everyone should practice while handling food.

Wash your hands with soap and water before handling food and wash your

hands often during food preparation, especially if you are handling raw

fish/chicken/meat.

Wash your hands with soap and water after going to the toilet. If you are

taking care of a baby, wash your hands after changing the diaper.

Wash and sanitize all surfaces and equipment used for food preparation.

Protect kitchen areas and food from insects, pests and other animals;

discard any food particles that may be in the kitchen sink, dispose rubbish

from the kitchen daily.

While most microorganisms do not cause disease, dangerous

microorganisms are widely found in soil, water, animals and people. These

microorganisms are carried on hands, wiping cloths and utensils, especially

cutting boards, and the slightest contact can transfer them to food and cause

food borne diseases.

Raw food such as meat, poultry and fish and their juice can contain

dangerous bacteria which may be transferred on to other foods during food

preparation and storage.

Separate raw meat, poultry and fish from other from other food. While

shopping, keep these separate from other foods. Store these in the

refrigerator below cooked or ready to eat food to avoid cross contamination.

43 | P a g e

Use separate equipment and utensils such as knives and cutting board for

raw meat, poultry and fish. Wash plates used for raw food. Use a clean

plate for covered food.

Store food in containers with lids to avoid contact between raw and

prepared food.

Cook thoroughly, specially meat, poultry, eggs and fish. Proper cooking

can kill almost all dangerous microorganisms. Special attention need to be

given if you are cooking the whole chicken. Make sure that juices are clear,

not pink.

Half boiled egg or eggs partially cooked should not be given to children

and should not be consumed during pregnancy and by people with low

immunity.

If you are reheating cooked food, it need to be done thoroughly.

If you are cooking in microwave, you need to know that microwave ovens

can cook unevenly and leave cold spots where dangerous bacteria can

survive, you need to make sure that food cooked in a microwave oven is at

a safe temperature throughout.

Some plastic containers release toxic chemicals upon heating. Only

microwave safe containers should be used in microwaves.

Do not leave cooked food at room temperature for more than 2 hours.

Refrigerate promptly all cooked and perishable food (preferably below 5 0C).

Keep cooked food hot prior to serving.

Do not store food for too long even in the fridge. Leftover food should not

be stored in the fridge for more than 3 days and should not be reheated

more than once.

44 | P a g e

Do not thaw frozen food at room temperature. Thaw in refrigerator or other

cool place.

Keep your refrigerator clean and do not over stock, it will reduce the

circulation of cool air and effect proper cooling. Frequent opening of

refrigerator/freezer door will affect the inside temperature.

Use safe water. Rain water collected in clean tanks is safe as long as tanks

are protected from contamination from birds and other animals. In

Maldives, contamination of rain water with cat feces is common, leading

to a chronic infection called toxoplasmosis. This causes blindness and

brain defects in the babies in the mother’s womb during pregnancy.

Therefore, it is important to make sure it is safe for consumption by proper

chlorination, filtration by a microbial filter system or boiling the water.

It is always better to use boiled rain water for consumption, especially if

you are giving it for children or pregnant women. Raw materials including

water and ice may be contaminated with dangerous microorganisms and

chemicals. Toxic chemicals maybe found in damaged and mouldy food.

Take care in selecting raw materials, washing and peeling could reduce the

risk.

Always wash fruits and vegetables before eating. Safe water should be used

to wash these.

Do not buy food that is damaged or rotten. Some shops may sell damaged

good at a cheaper price, however always think of your health first.

Do not buy any dented, swollen or rusted canned food.

9Adapted from: Five keys to safer food manual (2006): WHO

45 | P a g e

46 | P a g e

Exclusive breastfeeding for the first six months of life is essential for the good

health of the child. Similar, timely initiation and starting nutritionally-adequate,

safe, age-appropriate complementary feeding at six months is recommended for

the better health and development of the child. According to the Maldives

Demographic and Health Survey 2009, 47.8 % of the children are exclusively

breastfed up to 6 months of age and the median duration of exclusive breastfeeding

is only 2.2 months. By age 4-5 months, around three in four babies receives some

form of supplementation and complementary foods 1.

Promote, protect and sustain exclusive breastfeeding for the first six months

and continue breastfeeding till the child is 2 years and beyond.

Breastfeeding must be initiated within one hour after birth for all newborn

babies even if the baby is delivered by caesarean section, unless there is a

temporary or permanent medical condition contraindicating it. Breastfeed

on demand, both day and night.

Babies should not be fed other foods and fluids such as dates, honey, or

water in the first 6 months, and even at birth, as breast milk contains all the

water and other necessary nutrients a baby need for growth and brain

development.

If alternative feeding is required due to severe maternal or infant’s illness

or condition, it should be given with advice from a medical practitioner and

with consent of the mother/parents/guardians after explaining why it is

needed.

Start feeding additional (complementary) food to the child at the age of 6

months.

47 | P a g e

Complementary feeding should be

timely, meaning that all infants

should start receiving foods in

addition to breast milk from 6

months onwards. It should be

adequate, meaning that the

complementary foods should be

given in amounts, frequency,

consistency and using a variety of

foods to cover the nutritional needs

of the growing child while

maintaining breastfeeding.

Provide safe, appropriate and adequate complementary food for children

between 6 months and 2 years of age.

Homemade complementary foods are best, if using a commercial product

ensure that it is low in salt and sugar.

10Adapted from National guideline on optimal feeding of infant and young children (2016): Ministry of Health, Maldives.

48 | P a g e

Follow healthy dietary practices during pregnancy and lactation. The first 1000

days of life, the duration between pregnancy and the child’s second birthday is a

critical time for the child’s mental and physical development. Good nutrition status

of the mother and the child during this period can have a profound impact of child’s

growth and reduce risk of diseases.

Starting good nutrition practices and taking folic acid before you conceive

is ideal for a healthy pregnancy and the growth of your baby. Be sure to eat

a healthy diet of fresh fruits, vegetables, whole grains, low fat dairy

products, and lean meats and fish. Limit intake of deep fried food such as

short eats, pre-packaged foods, sugary drinks, and caffeine.

It is very important that you maintain a healthy weight before conceiving.

Obesity during pregnancy can bring many complications. Being

underweight also puts you and your unborn baby at risk of complications.

Folic acid can prevent

birth defects and help your

baby’s brain and spinal

cord to develop. Neural

development in your baby

happens before some

women even know they

are pregnant, so it is wise

to start folic acid

supplementation when you start considering having a baby, even from the

time of marriage.

It is very important to ensure you are eating healthy during pregnancy.

Eating a variety of nutritious foods is the best thing you can do to help your

changing body during pregnancy and ensure optimum growth and

development of your baby. Practicing good nutrition during your pregnancy

can help prevent complications and long-term health problems. Iron-

deficiency anaemia and gestational diabetes in pregnant women is a

problem in Maldives, and is mostly due to poor dietary habits.

49 | P a g e

Lack of important nutrients and foods high in sugar and unhealthy fats can

interfere with your health and the growth and development of your baby,

potentially causing premature delivery, low, or excessive birth weight, low

blood sugar levels of your baby, type 2 diabetes later in life, jaundice, birth

defects, birth injuries, and even stillbirth. Therefore, it is essential that you

try your best to eat nutritiously during your entire pregnancy.

Include Iron-rich foods include dark green leafy vegetables (like drumstick

leaves, massagu, kankun), lean red meat, fish, dates and beetroot, in your

diet. Eat foods containing vitamin C (most fruits and vegetables) with every

meal to enhance iron absorption. Avoid drinking tea or coffee during, just

before, or just after your meals as it can inhibit the absorption of iron. If you

are taking iron supplements (recommended by your doctor) and

experiencing constipation or stomach upset, do not stop taking your

supplements. Speak to your health care provider about the best options for

you.

If iron folic acid supplements are recommended by your doctor during

pregnancy and lactation, it is very important to take those. Deficiencies in

iron and folic acid during pregnancy can potentially negatively impact the

health of the mother, the pregnancy and fetal development.

If you don’t have enough calcium in your diet, your body will take it from

your own bones to give to your developing baby. This can cause negative

health conditions for you later in life, such as osteoporosis. Be sure to eat

plenty of calcium-rich foods such low-fat milk, unsweetened low-fat

yoghurt, cheese, spinach, rehi, kankun, and calcium-fortified cereals.

It is important that you gain the appropriate amount of weight during your

pregnancy. Too much or too little could have negative consequences for the

health of you and your baby. Women who are underweight at the start of

pregnancy (i.e. BMI < 18.5 kg/m2) should aim to gain 12.5–18 kg, women

who are normal weight at the start of pregnancy (i.e. BMI 18.5–24.9 kg/m2)

should aim to gain 11.5–16 kg, overweight women (i.e. BMI 25–

29.9 kg/m2) should aim to gain 7–11.5 kg, and obese women (i.e. BMI

> 30 kg/m2) should aim to gain 5–9 kg 12.

50 | P a g e

Breastfeeding mothers need to increase their water intake – at least 2-3 litres

of water for a day. Listen to your body’s signals of thirst and drink water.

Don’t ignore your thirst. Keep a glass of water nearby when you breast-feed

your baby to make it easier for you to reach. Avoid excessive intake of sugar

sweetened beverages. Too much sugar can contribute to weight gain.

Choose water as your preferred drink, over sugar-sweetened drinks.

Make healthy choices to help fuel your milk production. Choose protein rich

foods, such as lean meat, eggs, dairy, beans, lentils and fish. Choose a

variety of whole grains as well as fruits and vegetables.

11Adapted from Maternal and child health guide (2015): Ministry of Health, Maldives

12 WHO recommendations on antenatal care for a positive pregnancy experience ( 2016)

http://apps.who.int/iris/bitstream/10665/250796/1/9789241549912-eng.pdf

51 | P a g e

Adolescent health screening conducted nationwide in 2015 showed that

approximately a quarter had dental problems while 10 % had problems of

the oral cavity. Screening results showed that 16.04% percent boys and

12.24 % girls were overweight. It is alarming that13.18 % girls were

severely underweight while 6.15 % boys were severely underweight. The

report inferred that the students were not eating an adequate balance diet or

their diet is high in junk food. Studies have shown that overweight children

grow up to be overweight

adults hence we need to

instill good eating habits

early in life.

Energy and nutrient

requirement is increased

during adolescence

because it is the time that

rate of physical growth

increases, second only to

that in the first year of life.

Total nutrient needs are

higher during adolescence

than any other time in the

lifecycle. Failure to

consume an adequate diet at this time can result in delayed sexual

maturation and can arrest or slow linear growth. Nutrition is also important

during this time to help prevent adult diet-related chronic diseases, such as

cardiovascular disease, cancer, and osteoporosis.

It is important for parents to look out for signs of distorted body image

perception among children and adolescents. Do not criticize your child’s

appearance. This could affect their self-esteem. Remember that media can

use different techniques to create unrealistic body images.

Calcium requirement during adolescence are greater than they are in either

childhood or adulthood because of the dramatic increase in growth of bone.

Adolescence represents a “window of opportunity” for optimal bone

development and future health. Be a healthy role model for your friends.

52 | P a g e

Make the right choice and drink milk instead of drinks high in sugar. Your

future self will thank you for the strong bones you develop.

Healthy eating is fun. Try out new fruits and vegetables you have not tried

before.

Regular physical activity in adolescence improves strength and endurance,

helps build healthy bones and muscles and helps control weight among

other health benefits.

Being overweight or underweight

can be a concern during

adolescence. Trying fad diets to

lose weight is not recommended

and may harm your body. A

healthy diet will meet the energy

and other nutritional need without

providing excess or too little

energy.

Adolescents should aim to:

Enjoy a wide variety of nutritious foods from all 5 food groups:

o Different varieties and colours of vegetables

o Fruits

o Cereals and starchy vegetables, preferably whole grain cereals

o Lean meats and poultry, fish, eggs, legumes, nuts and seeds

o Milk, yoghurt and

cheese

Drink plenty of water

Limit intake of foods

containing saturated fat, added

salt and added sugars.

53 | P a g e

The process of ageing results in a decreased function of most systems in the body.

A sensory loss characterised by a decreased sense of smell and taste, causes loss

of appetite which could cause them to not like food usually prepared at home. Loss

of the ability to detect smells put them at the risk of food poisoning. Changes in

the digestive system could cause decreased absorption of nutrients, and hence their

energy needs increases. Loss of teeth leads to an inability to chew many foods and

prepared dishes prepared for the rest of the family. Therefore, older people need

foods that are soft, mashed or liquidized, and easy to consume. Due to loss of thirst

sensation puts them at the risk of dehydration. They should be encouraged to drink

enough water and other beverages.

It is necessary for older people to be mobile and more independent. However, in

our community we observe that elderly living in buildings without an elevator

hardly goes out unless there is a necessity. Some perceive roads not safe for them

due to increase in the number of vehicles on the road. Encourage elderly people

to be more active my providing them assistance and support. Encourage them to

go out, accompany them on morning and evening walks.

Osteoporosis commonly affects elderly, especially women after menopause.

Fractures of the hip, leg and wrist are common amongst the elderly. Once calcium

is lost from the bones it is difficult to replace, but there are ways to protect against

the disease from progressing, including getting enough calcium, fluoride and

vitamin D, as well as physical activity. Milk and milk products such as yoghurt

and cheese are high in calcium, and fish with soft, edible bones, such as rehi, are

also good sources of calcium. Hence it is recommended for women over 50 year

to include one extra serving of milk

and dairy products.

Depression among elderly could also

lead to low appetite and it would

impact the nutritional status of

elderly. Encourage them to eat more

when their appetite is good. Take care

of elderly and spend more time with

them.

Have healthy family meals together. Spend family time to exercise together, such

as swimming in the sea together or walking with an elderly family member.

Children can be encouraged to read or recite Qur’an with their grandparents.

54 | P a g e

Life style related chronic diseases such as high blood pressure, diabetes, high blood

cholesterol and certain types of cancers has been increasing in Maldivian

population at alarming rate. By eating healthy and being physically active at most

days of the week, we will be able to reduce the risk of getting these diseases.

Choose whole grains. Cut back on refined carbohydrates and sugary drinks.

Sugary soft drinks, high sugar fruit juice and sweetened milk causes quick

increases in blood sugar.

Follow the recommended servings of fruits and vegetables mentioned in

this guideline.

Select healthy fats and avoid deep frying. Restrict intake of wafers, cakes,

biscuits and deep fried short eats.

Exercise regularly to keep the body weight in check. Maintaining a healthy

weight helps to prevent NCDs.

Avoid using any form of tobacco or exposure to tobacco smoke. If you

smoke or chew tobacco, quit doing so.

Cut down salt.

Refrain from substance abuse.

55 | P a g e

Do not depend on health claims on food labels. The following will help you to

choose healthy foods and drinks, for yourself.

Nutrition Facts

Serving Size 3 pieces (26g)

Serving per container About 8

Amount per serving

Total Fat 4g

Choose foods with less than 10g per 100g. For

yogurt, choose less than 2g per 100g. For cheese,

choose less than 15g per 100g.

Saturated Fat 2g Less than 3g per 100g.

Trans fat 0g

Cholesterol omg

Sodium 220mg

Food with less than 400mg per 100g are good, and

less than 120mg per 100g is best.

Total Carbohydrate 18g

Dietary Fiber less than 1g

Sugar 1g Less than 5 g per 100g is good.

Protein 3g

Ingredients : Wheat flour,Vegetable oil(Palm oil),Milk powder,Yeast,Leavening(Ammon

ium Bicarbonate),Salt,Artificial food flavours,Coloured with

tumaric,Sodium metabisulphite.

Will be listed in descending order of predominance

by weight.

Expiry Date: Foods should not be eaten after the use by date and should not be

sold after this date because it could pose a health or safety risk.

Best before date: "Best before" dates are about quality. When the date is passed,

the food might begin to lose its flavour and texture.

The term "light" can mean "reduced in fat" or "reduced in energy" (Calories).

"Light" can also light tasting or light colored. “No added sugar” does not mean that

the product does not contain sugar. It simply means that sugar was not added during

processing.

56 | P a g e

Rice, lentils curry, grilled chicken, lettuce, carrot and steamed ladies

finger

Multigrain bread, omelet with moringa leaves and onion, papaya

and a glass of milk

Atta roshi, chickpeas, kankun leaves and passion fruit

Yam, fish soup (garudhiya), green

leaves (copee fayy), onions green chili, lime and grilled fish

Brown rice, pumpkin curry, moringa

leaves and grilled fish

Brown rice, spinach, grilled egg

plant, fish curry and pomegranate

Brown rice, snake gourd curry,

smoked tuna, cucumber, green leaves

salad and mango

Brown rice, drumstick curry ,

massaagufathu satani and grilled fish

Atta roshi, steamed snake guord

Oats cooked with milk,

banana and boiled egg

Atta roshi, steamed eggplant mixed

with tuna, onion, chili and lime

Atta roshi, steamed butternut

pumpkin mixed with tuna, onion,

lime and chilli